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1.
Medicine (Baltimore) ; 98(45): e17709, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702622

RESUMO

BACKGROUND: The rising maternal and child healthcare costs and the lack of training and educational resources for healthcare workers have reduced service quality in primary health centers of China. We sought to compare strategies promoting healthcare service utilization in rural western China. METHOD: A randomized community trial was carried out in Zhen'an country between 2007 and 2009. Two cross-sectional surveys were conducted to compare the outcomes of financial subsidy for pregnant women seeking antenatal care and clinical training provided to healthcare workers by difference-in-difference estimation. RESULTS: In all, 1113 women completed the questionnaires. The proportion of postnatal visits increased three times in the training group, reaching 35.7%. The number of women who received advice from their doctors regarding nutrition and warning signs necessitating immediate medical attention also improved significantly (5.8% and 8.2%, respectively). Furthermore, the percentage of women who underwent blood tests increased significantly to 19.5% in the training group. Compared to the financial group, the training group had more women who breastfed for longer than 4 months (15.8%) and provided timely complementary feeding (8.9%). CONCLUSION: The training intervention appeared to have improved prenatal care utilization. Essential obstetric training helped enhance knowledge and self-efficacy among healthcare workers.


Assuntos
Pessoal de Saúde/educação , Serviços de Saúde Materna/economia , Serviços de Saúde Rural/economia , Estudos Transversais , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Autoeficácia , Inquéritos e Questionários
2.
BMC Public Health ; 19(1): 1540, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752792

RESUMO

BACKGROUND: The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. METHODS: We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia's maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications' full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. RESULTS: A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. CONCLUSION: Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia's maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance - typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde , Serviços de Saúde Materna/economia , Austrália , Feminino , Humanos , Gravidez
3.
Int J Equity Health ; 18(1): 154, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615526

RESUMO

INTRODUCTION: In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC. AIM: Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso). METHODS: PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6-10 that was most successful. RESULTS: The average unit cost of health services for days 6-10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6-10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization. CONCLUSION: In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6-10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.


Assuntos
Serviços de Saúde Comunitária/economia , Redução de Custos/economia , Acesso aos Serviços de Saúde/economia , Serviços de Saúde Materna/economia , Adulto , Burkina Faso , Assistência à Saúde/economia , Eficiência Organizacional , Feminino , Humanos , Imunização/economia , Lactente , Cuidado Pós-Natal/economia , Período Pós-Parto , Gravidez
4.
BMC Health Serv Res ; 19(1): 645, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492134

RESUMO

BACKGROUND: Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality. METHOD: An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients. RESULTS: Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation. CONCLUSION: After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.


Assuntos
Serviços de Saúde Materna/economia , Cesárea/economia , Cesárea/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Quênia/epidemiologia , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Natimorto/epidemiologia
5.
Reprod Health ; 16(1): 84, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215495

RESUMO

BACKGROUND: Low socioeconomic status (SES) is associated with more adverse perinatal health outcomes, risk factors and lower access to and use of maternal health care services. However, evidence for the association between SES and maternal health outcomes is limited, particularly for middle-income countries like sub-Saharan Ghana. We assessed the association between parental SES and adverse maternal and perinatal outcomes of Ghanaian women during pregnancy, delivery and the postpartum period. METHODS: A prospective cohort study of 1010 women of two public hospitals in Accra, Ghana (2012-2014). SES was proxied by maternal and paternal education, wealth and employment status. The association of SES with maternal and perinatal outcomes was analyzed with multivariable logistic and linear regression. RESULTS: The analysis included 790 women with information on pregnancy outcomes. Average age was 28.2 years (standard deviation, SD 5.0). Over a third (n = 292, 37.0%) had low SES, 176 (22.3%) were classified to have high SES using the assets index. Nearly half (n = 374, 47.3%) of women had lower secondary school or vocational training as highest education level. Compared to women with middle assets SES, women with low assets SES were at higher risk for miscarriage (odds ratio, OR 1.61, 95% CI 1.06 to 2.45) and instrumental delivery (OR 1.74, 95% CI 1.03 to 2.94), but this association was not observed for the other SES proxies. For any of the maternal or perinatal outcomes and SES proxies, no other statistically significant differences were found. CONCLUSION: Women attending public maternal health care services in urban Ghana had overall equitable maternal and perinatal health outcomes, with the exception of a higher risk of miscarriage and instrumental delivery associated with low assets SES. This suggests known associations between SES, risk factors and outcomes could be mitigated with universal and accessible maternal health services.


Assuntos
Aborto Espontâneo/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Saúde Materna , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Parto Obstétrico , Feminino , Gana/epidemiologia , Humanos , Renda , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/normas , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/normas , Estudos Prospectivos , Fatores de Risco , Classe Social
6.
Obstet Gynecol ; 134(1): 180-181, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31241590
7.
BMC Public Health ; 19(1): 732, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185954

RESUMO

BACKGROUND: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. METHODS: The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. RESULTS: The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG's efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. CONCLUSION: Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/economia , Parto/psicologia , Pobreza/psicologia , Marginalização Social/psicologia , Adulto , Medo , Feminino , Grupos Focais , Gastos em Saúde/legislação & jurisprudência , Humanos , Índia , Islamismo/psicologia , Organizações , Grupos Populacionais/psicologia , Pobreza/economia , Gravidez , Classe Social , Responsabilidade Social
8.
Gen Hosp Psychiatry ; 59: 51-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163299

RESUMO

OBJECTIVE: Given the critical shortage of perinatal psychiatrists, combined with the prevalence of psychiatric conditions in the perinatal period, teleconsultation may help to maximize the efficiency of psychiatrists to reach this population. The Periscope Project (TPP) is a Wisconsin-based program offering real-time provider-to-provider teleconsultation, community resource information, and provider education. This paper describes model adaptations and implementation of TPP and the first 18 months of program data. METHOD: Enrollment and satisfaction data was collected via self-reported online surveys. Encounter data was entered by TPP team members through communication with providers. All data was housed in REDCap. RESULTS: Four hundred eight-five providers enrolled and 268 unique providers accessed services at least once. There were 594 encounters with 85% of encounters resulting in a teleconsultation. Mean call-back time from the psychiatrist was 6.8 min. Over half of utilizing providers practiced in obstetrical settings and 23% practiced in mental health settings. Provider satisfaction with the service was 100%. CONCLUSIONS: Utilization and satisfaction with TPP suggest that perinatal psychiatry access program models can vary in structure and process and experience similar utilization rates. Model adaptations are feasible and demonstrate the teleconsultation service is accepted by providers and may improve the population's health over time.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações na Gravidez/terapia , Desenvolvimento de Programas , Consulta Remota/estatística & dados numéricos , Adulto , Feminino , Humanos , Serviços de Saúde Materna/economia , Serviços de Saúde Mental/economia , Gravidez , Consulta Remota/economia , Wisconsin
9.
Health Policy Plan ; 34(4): 289-297, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31106346

RESUMO

Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.


Assuntos
Análise Custo-Benefício , Serviços de Saúde Materna/economia , Assistência Perinatal/economia , Etiópia , Feminino , Humanos , Recém-Nascido , Gravidez , Anos de Vida Ajustados por Qualidade de Vida
10.
Int J Gynaecol Obstet ; 146(1): 74-79, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31026343

RESUMO

OBJECTIVE: To analyze the cost-effectiveness of maternity waiting homes (MWHs) in rural Liberia by examining the cost per life saved and economic effect of MWHs on maternal mortality. METHODS: A cost-effectiveness analysis was used to evaluate costs and economic effect of MWHs on maternal mortality in rural Liberia to guide future resource allocation. A secondary data analysis was performed based on a prior quasi-experimental cohort study of 10 rural primary healthcare facilities, five with a MWH and five without a MWH, that took place from October 30, 2010 to February 28, 2015. RESULTS: Calculations signified a low cost per year of life saved at MWHs in a rural district in Liberia. Total population-adjusted number of women's lives saved over 3 years was 6.25. CONCLUSION: While initial costs were considerable, over a period of 10 or more years MWHs could be a cost-effective and affordable strategy to reduce maternal mortality rates in Liberia. Discussion of the scaling up of MWH interventions for improving maternal outcomes in Liberia and other low- and middle-income countries is justified. Findings can be used to advocate for policy changes to increase the apportionment of resources for building more MWHs in low resource settings.


Assuntos
Serviços de Saúde Materna/economia , Cuidado Pré-Natal/economia , Adulto , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Libéria , Morte Materna/prevenção & controle , Mortalidade Materna , Ensaios Clínicos Controlados não Aleatórios como Assunto , Gravidez , Cuidado Pré-Natal/métodos , População Rural
11.
BMC Pregnancy Childbirth ; 19(1): 135, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014279

RESUMO

BACKGROUND: There is growing demand for high quality evidence-based practice in the fight against negative maternal health outcomes in Sub-Saharan Africa (SSA). Zambia is one of the countries that has transposed this evidence-based approach by outlawing Traditional Birth Attendants (TBAs) and recommending exclusive skilled-care. There is division among scholars regarding the usefulness of this approach to maternal health in SSA in general. One strand of scholars praises the approach and the other criticizes it. However, there is still lack of evidence to legitimize either of the two positions in poor-settings. Thus the aim of this study is to fill this gap by investigating local people's views on the evidence-based practice in the form of skilled-maternal-care in Zambia, by using Mfuwe as a case study. METHODS: With the help of the Social Representation theory, Focus Group Discussions (FGDs) were conducted in Mfuwe, Zambia with 63 participants. FINDINGS: The study shows that the evidence-based strategy (of exclusive skilled-care) led to improved quality of care in cases where it was accessible. However, not all women had access to skilled-care; thus the act of outlawing the only alternative form of care (TBAs) seemed to have been counterproductive in the context of Mfuwe. The study therefore demonstrates that incorporating TBAs rather than obscuring them may offer an opportunity for improving their potential benefits and minimizing their limitations thereby increasing access and quality of care to women of Mfuwe. CONCLUSION: This study illustrates that while evidence-based strategies remain useful in improving maternal care, they need to be carefully appropriated in poor settings in order to increase access and quality of care.


Assuntos
Atitude Frente a Saúde , Prática Clínica Baseada em Evidências , Serviços de Saúde Materna , Qualidade da Assistência à Saúde , Prática Clínica Baseada em Evidências/economia , Feminino , Humanos , Saúde Materna , Serviços de Saúde Materna/economia , Tocologia/economia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Saúde da População Rural , Zâmbia
12.
Health Care Women Int ; 40(12): 1374-1395, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30985260

RESUMO

In this study, we estimate the effects of health insurance on the out-of-pocket expenditure on health care for maternal delivery in Indonesia. Distinguishing between the types of health insurance, we explore heterogeneity in the size of the impact of noncontributory insurance for poor households vis-à-vis contributory insurance for nonpoor households. We find that noncontributory insurance and contributory insurance reduce the average out-of-pocket expenditure by 1,136,966 IDR ([Formula: see text]) and 676,402 IDR ([Formula: see text]), respectively. Also, larger impacts of noncontributory insurance and contributory insurance are found at the right tail of the distribution.


Assuntos
Parto Obstétrico/economia , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Seguro Saúde/economia , Serviços de Saúde Materna/economia , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Indonésia , Seguro Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Características de Residência , Classe Social
13.
Glob Health Sci Pract ; 7(Suppl 1): S104-S122, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30867212

RESUMO

The primary objective of this study was to estimate the costs and the incremental cost-effectiveness of maternal and newborn care associated with the Saving Mothers, Giving Life (SMGL) initiative-a comprehensive district-strengthening approach addressing the 3 delays associated with maternal mortality-in Uganda and Zambia. To assess effectiveness, we used a before-after design comparing facility outcome data from 2012 (before) and 2016 (after). To estimate costs, we used unit costs collected from comparison districts in 2016 coupled with data on health services utilization from 2012 in SMGL-supported districts to estimate the costs before the start of SMGL. We collected data from health facilities, ministerial health offices, and implementing partners for the year 2016 in 2 SMGL-supported districts in each country and in 3 comparison non-SMGL districts (2 in Zambia, 1 in Uganda). Incremental costs for maternal and newborn health care per SMGL-supported district in 2016 was estimated to be US$845,000 in Uganda and $760,000 in Zambia. The incremental cost per delivery was estimated to be $38 in Uganda and $95 in Zambia. For the districts included in this study, SMGL maternal and newborn health activities were associated with approximately 164 deaths averted in Uganda and 121 deaths averted in Zambia in 2016 compared to 2012. In Uganda, the cost per death averted was $10,311, or $177 per life-year gained. In Zambia, the cost per death averted was $12,514, or $206 per life-year gained. The SMGL approach can be very cost-effective, with the cost per life-year gained as a percentage of the gross domestic product (GDP) being 25.6% and 16.4% in Uganda and Zambia, respectively. In terms of affordability, the SMGL approach could be paid for by increasing health spending from 7.3% to 7.5% of GDP in Uganda and from 5.4% to 5.8% in Zambia.


Assuntos
Morte Materna/prevenção & controle , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/organização & administração , Análise Custo-Benefício , Feminino , Humanos , Recém-Nascido , Mortalidade Materna/tendências , Gravidez , Uganda/epidemiologia , Zâmbia/epidemiologia
14.
Int J Health Plann Manage ; 34(2): e1334-e1345, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924204

RESUMO

OBJECTIVE: To compare the health care expenditures between maternity waiting home (MWH) users and nonusers in Ethiopia. METHODS: A cross-sectional study was done in Ethiopia between December 2017 and June 2018. The study setting included eight health facilities in the Gurage zone of Ethiopia. Health expenditure for delivery care was the outcome variable that was then classified into out-of-pocket (OOP) payments, women's costs, total costs, and overall costs. Those health expenditures were then compared among MWH users and nonusers. OOP payments were further analyzed using quantile regression to explore associated factors. RESULTS: A total of 812 postpartum women were included in this study of whom half were MWH users. Significantly higher OOP payment, women's costs, total costs, and overall cost were found among MWH users compared with nonusers regardless of duration of MWH stay. The MWH users were more likely to have higher OOP payment compared with MWH nonusers in linear and quantile regressions for both unadjusted and adjusted analyses. Higher OOP payments were observed for longer distance traveled and cesarean section (CS) delivery women at the 75th and 90th quantiles of expenditure. Using public transportation was significantly associated with higher OOP payment in all quantile levels. CONCLUSION: Utilization of MWH incurred higher OOP payments, total costs, women's costs, and overall costs compared with MWH nonusers. Higher OOP payments for delivery care among MWH users were observed in all quantiles of expenditure.


Assuntos
Parto Obstétrico/economia , Gastos em Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Etiópia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Adulto Jovem
15.
Health Policy Plan ; 34(3): 216-229, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30903167

RESUMO

Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. These include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care. Similarly, there are proximal and distal impacts, including on household finances, patient satisfaction and provider morale. Informal payments have been studied and addressed from a variety of different perspectives, including anti-corruption, ethnographic and other in-depth qualitative approaches and econometric modelling. Summarizing and discussing the advantages and disadvantages of these and other paradigms illustrates the value of an inter-disciplinary approach. The same tacit, hidden attributes that make informal payments hard to measure also make them hard to discuss and address. A multidisciplinary health systems approach that leverages and integrates positivist, interpretivist and constructivist tools of social science research can lead to better insight. With this, we can challenge 'master narratives' and meet universalistic, equity-oriented global health objectives.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/economia , Feminino , Financiamento Pessoal/estatística & dados numéricos , Pessoal de Saúde/economia , Pessoal de Saúde/psicologia , Humanos , Satisfação do Paciente , Gravidez
17.
Health Policy Plan ; 34(2): 120-131, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30843068

RESUMO

This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1.33, P = 0.014]. Early ANC initiation (aOR: 1.32, P = 0.001) and use of private sector ANC (aOR: 1.93, P < 0.001) were also positively associated with use of continuous care among ANC users. Among continuous care users, early ANC was associated with increased odds of completing the maternal health pathway as recommended (aOR: 3.80, P < 0.001). Higher parity was negatively associated with all three outcomes, while having health insurance was positively associated with each outcome. The impact of other sociodemographic factors such as maternal age, education, wealth quintile, urban residence, and employment varied by outcome; however, the findings generally suggest that marginalized women faced greater barriers to early ANC initiation and continuity of care. Health financing and women's timing and source of ANC are strongly related to their subsequent progression through the maternal health pathway. To increase continuity of care and improve maternal health outcomes, policymakers must therefore focus on equitably reducing financial and other barriers to care seeking and improving quality of care throughout the continuum.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Quênia , Paridade , Cuidado Pós-Natal/economia , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
18.
BMC Health Serv Res ; 19(1): 148, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841870

RESUMO

BACKGROUND: While local context costing evidence is relevant for healthcare planning, budgeting and cost-effectiveness analysis, it continues to be scarce in Ethiopia. This study assesses the cost of providing a prevention of mother-to-child transmission of HIV/AIDS (PMTCT) service across heterogeneous prevalence (high, low) and socio-economic (urban, rural) contexts. METHODS: A total of 12 health facilities from six regions in Ethiopia were purposively selected from the latest 2012 antenatal sentinel HIV prevalence report. Six health facilities with the highest HIV prevalence (8.1 to 17.3%) in urban settings and six health facilities with the lowest prevalence (0.0 to 0.1%) in rural settings were selected. A micro-costing approach was applied to identify, measure and value resources used for the provision of a comprehensive PMTCT service. The analysis was conducted across different PMTCT service packages. We also estimated national costs in urban and rural contexts. RESULTS: The average cost per pregnant woman-infant pair per year (PPY) ranged from ETB 6280 (USD 319) to ETB 21,620 (USD 1099) in the urban high HIV prevalence health facilities setting. In rural low HIV prevalence health facilities, the cost ranged from ETB 4323 (USD 220) to ETB 7539 (USD 383).PMTCT service provision in urban health facilities costs more than twice the cost in rural health facilities. The average cost per PPY in an urban setting was more than double the cost in a rural setting due to the higher cost of inputs and possible inefficiencies (although there were a higher number of visits). Consumables (including antiretroviral drugs) and infrastructure were the major cost drivers in both the urban and rural health facilities. Among PMTCT service components, anti-retroviral treatment Option B+ follow-up and counselling accounted for the highest proportion of costs, which ranged from 58 to 72%. Nationally, at the current coverage, the cost of PMTCT service was USD 6 million and USD 3 million in urban and rural settings, respectively. CONCLUSIONS: The analysis suggests that resources used for PMTCT service packages varied across health facilities and HIV prevalence contexts. Providing PMTCT service in the high HIV prevalence urban health facilities costs more than in the rural facilities. Context-specific costing was vital to provide locally sensitive evidence for health service management and priority setting.


Assuntos
Infecções por HIV/prevenção & controle , Instalações de Saúde , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Serviços de Saúde Materna/economia , Saúde da População Rural , Saúde da População Urbana , Criança , Análise Custo-Benefício , Etiópia , Feminino , Infecções por HIV/epidemiologia , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/economia , Serviços de Saúde Materna/organização & administração , Gravidez
19.
Policy Polit Nurs Pract ; 20(1): 28-40, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30791813

RESUMO

Early home visiting is a vital health promotion strategy that is widely associated with positive outcomes for vulnerable families. To expand access to these services, the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was established under the Affordable Care Act, and over $2 billion have been distributed from the Health Resources and Services Administration to states, territories, and tribal entities to support funding for early home visiting programs serving pregnant women and families with young children (birth to 5 years of age). As of October 2018, 20 programs met Department of Health and Human Services criteria for evidence of effectiveness and were approved to receive MIECHV funding. However, the same few eligible programs receive MIECHV funding in almost all states, likely due to previously established infrastructure prior to establishment of the MIECHV program. Fully capitalizing on this federal investment will require all state policymakers and bureaucrats to reevaluate services currently offered and systematically and transparently develop a menu of home visiting services that will best match the specific needs of the vulnerable families in their communities. Federal incentives and strategies may also improve states' abilities to successfully implement a comprehensive and diverse menu of home visiting service options. By offering a menu of home visiting program models with varying levels of service delivery, home visitor education backgrounds, and targeted domains for improvement, state agencies serving children and families have an opportunity to expand their reach of services, improve cost-effectiveness, and promote optimal outcomes for vulnerable families. Nurses and nursing organizations can play a key role in advocating for this approach.


Assuntos
Financiamento de Capital/economia , Serviços de Saúde da Criança/economia , Visita Domiciliar/economia , Serviços de Saúde Materna/economia , Patient Protection and Affordable Care Act/economia , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos
20.
Int J Health Plann Manage ; 34(2): 619-635, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30615218

RESUMO

OBJECTIVE: To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities. METHODS: Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before. RESULTS: MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE-severity in MM was -4% (P < 0.01). CONCLUSIONS: Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.


Assuntos
Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mortalidade Materna , Adulto , Financiamento Governamental/economia , Acesso aos Serviços de Saúde/economia , Humanos , Incidência , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , México/epidemiologia , Modelos Econométricos , Modelos Estatísticos , Alocação de Recursos , Fatores Socioeconômicos , Análise Espacial , Adulto Jovem
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